title: The shortfall in long-term survival of patients with repaired thoracic or abdominal aortic aneurysms: retrospective case-control analysis of hospital episode statistics.
abstract: OBJECTIVE
  To report the contemporary life expectancy of patients undergoing abdominal (AAA) or thoracic aortic aneurysm (TAA) repair in England, relative to a healthy control population.
  
  
  METHODS
  A retrospective observational case-control study was carried out of Hospital Episode Statistics (HES) data, an administrative dataset covering the entire English National Health Service. Patients undergoing elective repair of an abdominal or thoracic aortic aneurysm in an English NHS hospital between April 2006 and March 2011 were included. Outcome measures were 5-year all-cause mortality (in- and out-of-hospital) and adverse cardiovascular events (myocardial infarction, stroke, emergency amputation or limb revascularisation).
  
  
  RESULTS
  19,505 AAA and 730 TAA repairs were identified, with 75,260 and 2,721 control participants, respectively, and 27.5 (1.0-60.0) months' median (range) follow-up. Five-year survival was 67.4% for AAA against 81.1% for control participants, and 65.3% for TAA against 89.1% for control participants (p < .001). Freedom from adverse cardiovascular events was 86.1% for AAA against 93% for control participants and 89.1% for TAA against 94.4% for control participants (p < .001).
  
  
  CONCLUSIONS
  Long-term survival remains poor after aneurysm repair and adverse cardiovascular events are common relative to the wider population. Further research is required to characterise and optimise cardiovascular risk prevention in patients with aortic aneurysms.
authors.affiliation: St George's Vascular Institute, St George's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: S S
authors.initials: SS
authors.lastname: Bahia
authors.forename: B O
authors.initials: BO
authors.lastname: Patterson
authors.forename: G
authors.initials: G
authors.lastname: Peach
authors.forename: A
authors.initials: A
authors.lastname: Vidal-Diez
authors.forename: K K
authors.initials: KK
authors.lastname: Ray
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D004739:England / Q000453:epidemiology; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: Abdominal aortic aneurysm; Long-term survival; Shortfall; Survival; Thoracic